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oining the Medical Order for Life Sustaining Treatment (MOLST) initiative, Maryland has implemented this new form that a physician or nurse practitioner completes that indicates a person’s wishes in respect to life-sustaining treatments, according to a Baltimore Sun interview with Dr. Barbara Carroll, MD, the medical director at Broadmead, a senior living community. Other states that provide MOLST guidelines are New York, Massachusetts and Delaware.

Good old Earl Blumenauer. A bespectacled and bowtied Congressman from Oregon. He of the “death panel” proposal. Thank God he’s still here. Presuming that the crazy talk over the provision in the Affordable Care Act that would have paid doctors to discuss end-of-life issues with patients is over, he has introduced a separate bill with this provision and hopes to get it passed in the next couple of years.

Talking about death — even thinking about death — is uncomfortable for patients and families. Nearly 80 percent of us would prefer to spend our last days at home, but the majority of us will die in the hospital, and only 20 percent of us have expressed our wishes in writing.

In theory, or in a more perfect universe, our family members wouldn’t have a hard time deciding what to do when we were near death. However painful the task, the decisions would be clear: We would have prepared a written document, an advance directive, stating what we wanted doctors to do or not do, and our about-to-be survivors would follow our instructions. Simple.

For most people, planning for death isn’t their choice way of spending an afternoon. Most people avoid the thought altogether, until they get older and accept death as just another part of life. As most people know, your death doesn’t only affect you; it affects everyone that you surround yourself with, and it’s important that you leave this world on good terms. There are many ways to make amends with your loved ones before passing, but of these things are a few that stand out above the rest.

Give Representative Earl Blumenauer, a nine-term Democrat from Oregon, credit for two things. First, a sense of humor: He began an op-ed piece he wrote for The New York Times a few years back with, “I didn’t mean to kill Grandma.” He sometimes adopts the very phrase he got slurred with in 2010, referring to himself, ironically, as “the death-panel guy,” just as the president and his administration now embrace “Obamacare.”

Clinicians use the DNR order not only as a guide for therapeutic decisions during a cardiopulmonary arrest but also as a surrogate for broader treatment directives. Most clinicians believe that DNR discussions should take place earlier than they actually do. Interventions aimed at improving clinician knowledge and skills in advance care discussions as well as the development of orders that address overall goals of care may improve care for children with serious illness.

A new, patient-centered ACP website that focuses on preparing patients for communication and decision making significantly improves engagement in the process of ACP and behavior change. A clinical trial of PREPARE is currently underway.